Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project ID: 1000759 DEA: 074X9704 EFIS: 0716000335
QA Service Level: 1
DIST-CO-RTE-PM: 07-LA,-1-42.4
Work Description: CONSTRUCT DRILLED HOLE AND DRILLED HOLE (ROCK SOCKET).
Location Description: LOS ANGELES COUNTY IN MALIBU AT 0.1 MILE SOUTH OF BIG ROCK DRIVE
Contractor Name: BEADOR CONSTRUCTION COMPANY, INC.
Contractor Address: 2900 Bristol Street, Suite D204, Costa Mesa, CA 92626
Resident Engineer: Elizabeth Martinez Structure Rep.: Frank Lotfi
DIME Sample ID: 2025-09-29-36
TL Number from the TL Form:
Sample Submitted By Organization: CT D08 - Fontana Southern Regional Laboratory
Sample Organization Contact: 213-792-4794
Type of Sample: Production Start-Up
Type of Material: Hot Mix Asphalt
Sample Taken Date: 09/29/2025
Date that the sample was received by the laboratory/organization performing the testing: 10/03/2025
The quantity of what the sample constitutes: 14 BX HMA 4 QT PG64-10 2 BG CMB AGG 2 BG RAP
A brief description of the sample: 3/4" HMA A SP R15 NO LAS
From where was the sample collected: Manufacturer
Laboratory sample identification: 0625A-25
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: AAA - CORONA
